Phakamile Hlubi-Majola: NHI can succeed if we follow Cuba’s example

President Cyril Ramaphosa’s signing of the National Health Insurance (NHI) bill was a missed opportunity for the ruling party.

It could have really changed healthcare for the majority of South Africans. Don’t get me wrong: I support the noble principle of universal healthcare for all and this must be defended. But I have some concerns.

The NHI is the ANC’s attempt to fulfill a promise it made thirty years ago. It is possible that this will result in an improvement in healthcare, but with the involvement of the private sector, I doubt that the poorest will really benefit.

The South African healthcare system is extremely unequal. It consists of two layers: one consists of the private sector and one of the public sector. The public sector serves about 80% of the population in old, dilapidated, crumbling state facilities that have an acute shortage of doctors and nurses. There is a drastic shortage of resources and grossly understaffed. The buildings’ infrastructure is falling apart as the state has implemented budget cuts and drastically cut health care spending.

Every day there are chronic shortages of medicines and essential items. Patients are often stripped of their dignity because the conditions are terrible. We must salute the healthcare workers who carry this broken system on their backs, and ensure that some level of service is provided to the people, despite the government’s senseless decision to suffocate it through crippling austerity measures.

South Africa’s ‘Wealth-care’ system

The private sector, on the other hand, serves a fraction of the population, less than 20%. It has an abundance of specialists and doctors, and the facilities are world-class and designed to serve a minority of people, who are fortunate enough to have a job and can afford medical care.

Right-wing organizations are lining up to rush to court. The bill was ‘rushed’ and ‘haphazard’, they say; “So it should be scrapped altogether.” Their real agenda is to deny quality healthcare to the masses. They fight to preserve their privileges and the profits of the private sector.

Some of the hysteria around this is fueled by racism and also the worst form of elitism. The outrage machine of the traditional media is at full blast amplifying the voices of the affluent members of the middle class, who are clutching their pearls in horror at the very idea of ​​sharing the same hospital ward with their domestic workers. .

The manufactured moral panic reminds me of the hysteria I witnessed in the early 1990s, when white people in South Africa realized that by the end of apartheid they would have to share their pristine public schools with African students. Suddenly there was a mass exodus of white children from public schools. These are people who have an ideological or racial aversion to democracy and get a kick out of burning flags. The crazy edge.

The NHI Act: 30 years in the making

There are genuine concerns about how NHI will be rolled out. People are rightly wary of corruption and mismanagement of these funds, given the ruling party’s destructive history when it comes to public finance management.

And there are others, like me, who question the sincerity of the state to end health inequality. The NHI Act still plans to rely heavily on the private sector for healthcare. And this is where the problem lies. Allowing the private sector to participate in the system will create the very conditions that led to the status quo.

It is inexcusable that the working class has not had access to quality healthcare services for the past thirty years because this government has chosen to promote the profits of private capital over the well-being of the majority of people.

After the end of apartheid, the South African state had the opportunity in 1994 to create a framework that would lead us to truly universal access to healthcare for all. According to the Parliamentary Monitoring Group, several iterations on the type of health insurance were discussed and discussed by Parliament as early as 1994. The report states:

“The possibility of introducing some form of compulsory health insurance and after the 1994 elections; there were several policy initiatives that took into account social or national health insurance.”

Fast track to 2009, which culminated in the formation of the Advisory Committee on National Health Insurance and subsequently the publication of the ‘White Paper’ on the NHI, released by the Ministry of Health in 2015. And the rest is history.

It has taken an extremely long time for the NHI Act to be passed, and in that time the private healthcare sector has cemented its dominance. One of the most worrying aspects of private healthcare in South Africa is the cost. According to a report compiled by the World Health Organization and the Organization for Economic Co-operation and Development (OECD), published in 2018, the following was found:

“South Africa spends 41.8% of total healthcare expenditure on private voluntary health insurance – more than any OECD country – but only 17% of the population – mainly high-income citizens – can afford to take out private insurance .”

The research shows that we spend as much on healthcare as France and Germany, despite having the lowest GDP per capita of the sampled countries. To add salt to the wound, the state subsidizes the private medical aid industry with billions in tax credits.

The Cuban Healthcare Standard: A Socialist Success Story

If we want examples of what access to universal health care looks like, we should learn from Cuba. Despite being subjected to crippling sanctions for decades by imperialist America and its NATO allies, the country has managed to build the best healthcare system in the world, free for all its citizens. This was achieved by completely overhauling the profit-based healthcare system and training an army of healthcare workers to care for the community.

The Cuban healthcare system is built on the socialist principles of providing quality healthcare to all. It focuses on prevention and is based on primary health care, accompanied by social involvement. According to Newsweek, life expectancy in Cuba is higher than that of the US. Cuban health workers have eliminated polio, and the country has the lowest HIV rate in Latin America. Malnutrition is lower among Cuban children than among American children. Cuba has achieved this incredible feat in part because it has the highest physician-to-population ratio in the world, with approximately 8.4 physicians per 1,000 residents.

There is a GP and nurse model, a health care team that lives in the community and carefully records diseases and treatments while providing basic health care. The system depends on volunteer brigades that build mini outpatient clinics throughout the country.

In addition, Cuban healthcare workers serve the world by providing much-needed medical assistance during natural disasters and other catastrophic events. Some countries are happy with the help they receive from Cuban doctors, without recognizing that it is Cuba’s socialist system that produces the best results. Cuba is able to focus its meager resources on training and equipping health care workers because it values ​​all human life.

The success of the NHI, as it currently exists, is open to question. By ignoring Cuba’s healthcare model, which does not involve private healthcare providers, the government risks perpetuating the inequalities of the current two-tier system.

That fact, combined with an ill-defined implementation period, makes it appear as if the ANC government is once again going out of its way to accommodate corporate interests at the expense of all South African citizens.

* Phakamile Hlubi-Majola is a socialist and former journalist. She writes in a personal capacity.